'When you hear hoofbeats, think of horses not zebras' - the old adage is well-known to GPs but what should you do when faced with a zebra, not a horse? Consultant cardiologist Professor Robert Tulloh and GP Dr Louise Tulloh kick off our new series with their advice on how to catch Kawasaki disease in general practice.

Exclusive Patients are attending hospitals for pre-operative tests only to have surgery cancelled as PCTs strip waiting lists of those whose treatment is deemed ‘low clinical priority', LMC leaders are claiming.

GPs across north London and in Berkshire, Buckinghamshire and Oxfordshire have been alerted to a fresh care-rationing drive, after an LMC reported patients were having scheduled operations cancelled after being judged not to meet new referral criteria.

It is the first time reports have emerged of GPs having referrals initially accepted, only for patients to later have treatments cancelled as thresholds for low clinical priority are applied retrospectively.

Buckinghamshire, Berkshire and Oxon LMCs attacked the ‘unfair' move and said original decisions to accept GP referrals should be honoured.

NHS North Central London triggered concerns it too would cancel scheduled surgery after this month launching a new Procedures of Low Clinical Effectiveness (POLCE) policy, which ‘strengthens clinical criteria' for treatment.

Dr Jim Kennedy, medical director of Bucks, Berks and Oxon LMCs, said: ‘Patients have gone down the pathway after being accepted under old thresholds and suddenly are denied care using a different threshold. That is clearly unfair.

‘Our main priority is to make sure if a patient is admitted under one set of criteria, those rules are applied throughout the process.'

NHS Buckinghamshire said its low clinical priority treatment list covered a range of treatments including cosmetic procedures, bunion removal and ganglion treatment, and insisted its low priority thresholds had not been ‘significantly changed' this financial year.

But a spokesperson added: ‘The PCT did discover 64 patients who had been referred for treatment despite not meeting the referral criteria when it reviewed waiting lists earlier this year. These patients were subsequently removed.'

Dr Tony Grewal, medical director of Londonwide LMCs and a GP in Hillingdon, north-west London, said he was aware of the Buckinghamshire reports: ‘I am aware of a number of cases where a patient had been listed for a procedure and then arrived at the hospital pre-op checks to be told that things had changed and they had to go back to their GP for special permission to get the treatment.'

‘It is completely unacceptable. It's grotesquely unfair on patients who will have been, quite reasonably, anxious about undergoing treatment. To then cancel it and make patients and GPs go through the whole process again means additional delay, additional stress and additional work for all concerned and, understandably, a very unhappy patient.'

North London LMCs called for an ‘urgent review' of North Central London PCT cluster's POLCE policy, and the cluster said it planned ‘to review the issue as a matter of urgency'.

RCGP chair Dr Clare Gerada, a GP in Kennington, south London, said: ‘Patients must not be treated as commodities and pushed back and forwards.'

This comes after health secretary Andrew Lansley attacked PCTs for 'unfair practices' to reduce care yesterday, and said minimum waiting times and caps on operations will be banned.